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High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics.

Publication ,  Journal Article
Lee, TWR; Grocott, HP; Schwinn, D; Jacobsohn, E; Winnipeg High-Spinal Anesthesia Group,
Published in: Anesthesiology
February 2003

BACKGROUND: This double-blind, randomized, controlled trial examined the effect of high-dose intrathecal bupivacaine in combination with general anesthesia on atrial beta-adrenergic receptor function, the stress response, and hemodynamics during coronary artery bypass graft surgery. METHODS: Thirty-eight patients were randomized to either control (n = 19) or intrathecal bupivacaine (ITB) groups (n = 19). Patients in the ITB group received 37.5 mg intrathecal hyperbaric bupivacaine before induction of general anesthesia. Control patients received an injection of local anesthetic into the skin and subcutaneous tissues (sham spinal). Comparisons were made between groups with respect to atrial receptor desensitization and down-regulation, in addition to circulating catecholamines and hemodynamics. RESULTS: In patients with cardiopulmonary bypass (CPB) times in excess of 1 h, the ITB group had significantly less atrial beta-receptor dysfunction, as measured by maximal isproteronol, 50% maximal isoproterenol, sodium fluoride-stimulated activity, and zinterol stimulation assays of adenylyl cyclase activity (P < or = 0.02) and beta-adrenergic receptor density (P = 0.02). Serum epinephrine, norepinephrine, and cortisol concentrations were significantly lower in the ITB group, independent of CPB times (P < 0.0001, P < 0.001, and P < 0.05, respectively). ITB patients had a higher cardiac index and a lower pulmonary vascular resistance index in the post-CPB time period (P < 0.01 and P < 0.05, respectively). In the pre-CPB period, mean arterial pressure and systemic vascular resistance index were significantly lower in the ITB group. CONCLUSIONS: High-dose intrathecal bupivacaine, when combined with general anesthesia, resulted in less beta-receptor dysfunction and a lower stress response during coronary artery bypass graft surgery.

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Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

February 2003

Volume

98

Issue

2

Start / End Page

499 / 510

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stress, Physiological
  • Respiratory Function Tests
  • Receptors, Adrenergic, beta
  • Pulmonary Gas Exchange
  • Middle Aged
  • Male
  • Isoproterenol
  • Humans
  • Hemodynamics
 

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Lee, T. W. R., Grocott, H. P., Schwinn, D., Jacobsohn, E., & Winnipeg High-Spinal Anesthesia Group, . (2003). High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics. Anesthesiology, 98(2), 499–510. https://doi.org/10.1097/00000542-200302000-00032
Lee, Trevor W. R., Hilary P. Grocott, Debra Schwinn, Eric Jacobsohn, and Eric Winnipeg High-Spinal Anesthesia Group. “High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics.Anesthesiology 98, no. 2 (February 2003): 499–510. https://doi.org/10.1097/00000542-200302000-00032.
Lee TWR, Grocott HP, Schwinn D, Jacobsohn E, Winnipeg High-Spinal Anesthesia Group. High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics. Anesthesiology. 2003 Feb;98(2):499–510.
Lee, Trevor W. R., et al. “High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics.Anesthesiology, vol. 98, no. 2, Feb. 2003, pp. 499–510. Pubmed, doi:10.1097/00000542-200302000-00032.
Lee TWR, Grocott HP, Schwinn D, Jacobsohn E, Winnipeg High-Spinal Anesthesia Group. High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics. Anesthesiology. 2003 Feb;98(2):499–510.

Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

February 2003

Volume

98

Issue

2

Start / End Page

499 / 510

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stress, Physiological
  • Respiratory Function Tests
  • Receptors, Adrenergic, beta
  • Pulmonary Gas Exchange
  • Middle Aged
  • Male
  • Isoproterenol
  • Humans
  • Hemodynamics